Coming Back from Serious Injury

So you have had a serious injury, such as a stress fracture, and you have rested and recovered. Now comes the next step: What should you do when the doctor finally gives you the green light to begin running again?

The answer to that question depends on the site and severity of the injury, how long you were off running, and your overall health and fitness level. It takes an average of three months for a stress fracture to heal completely. That means that although you may be able to resume running six to eight weeks after the initial diagnosis, it is critical to start back slowly and increase your mileage gradually to allow the final healing to take place.

These guidelines should help you resume your normal training and racing after a serious injury.

How Far, How Fast and How Often?

Before you can run you must be able to walk briskly without pain. This will help determine when the injured bone will be able to handle the impact forces of running. When you can walk steadily without pain for 60 minutes, you should be able to try small doses of running.

The purpose of your first runs is simply to get your body used to the running motion again. You may feel as though you have never run before. It's normal to experience some soft-tissue discomfort as your muscles get used to running again. However, if you have pain in the area that was injured, then you have not healed sufficiently to run. Stop right away and consult your doctor. Trying to run through the pain could severely set back your recovery.

Start out by alternating walking and running. Walking will warm up your muscles, and the breaks will give you a chance to evaluate how you feel. You'll have a lot of pent-up physical and emotional energy, and you may be tempted to do more than you should. Alternating walking and running will help keep your demons in check. Gradually extend the running segments and shorten the walking breaks until you are back to continuous running. Even at this point, run only every third day or every other day to give your bones, ligaments, tendons and muscles time to adapt to the stresses of running. You can then progress to two consecutive days running and one day off, then three consecutive days, etc. Of course, avoid the factors that caused the injury in the first place, such as worn-out shoes, running on concrete, or excessive downhill running.

Back to Full Speed

The time required to return to full training generally ranges from six weeks to four months; in extreme cases it may take as long as a year. You must build up the distance, frequency and intensity of your runs very gradually. Continue with alternative activities such as water running and cycling. It will take several weeks before you are running far enough or hard enough to improve your cardiovascular fitness; during this time, your hard sessions will have to remain in the pool or on the bike.

Don't attempt to increase running distance, frequency and intensity all at once. Build up the distance and the frequency first while keeping the intensity moderate. After a month of this base work, gradually add higher-intensity workouts such as tempo runs and long intervals.

A Sample Program

The schedule below is based on the recovery programs of several runners who had fractures of the tibia and metatarsals. Time off from running varied from four to eight weeks. Your own situation may differ substantially, so your training may progress at a different rate. Follow the principles discussed here and listen to your body's feedback.

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